Via La Coruna Manor

Type of visit: Case Management - Health Checks

On September 1, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. Licensee (LI) Allen Medina was notified via telephone and later arrived to assist with the inspection. LI allowed LPA access to the property upon his arrival. During the visit, LI informed LPA that he would like to surrender the license for the facility. LPA, accompanied by the LI, then conducted a tour of the premises including the interior and exterior portions of the facility. LPA inspected the four resident bedrooms and observed them to be vacant. LPA inspected all other common areas including the living, dining room, kitchen, and two car garage and observed them to be free of any hazards. LPA confirmed during the visit that the facility is currently not operational and that there are no residents in care. The LI informed LPA that the last resident moved out of the facility on July 31, 2026. LPA collected the physical facility license during the visit. LPA informed the LI that Community Care Licensing will close the facility and that the forfeiture of license letter would be mailed to their address. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Allen Medina and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Case Management - Health Checks

On August 12, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by Licensee (LI) Maricel Nepomuceno after explaining the purpose for the visit. On today's visit, LPA observed there are no residents in care and the facility is currently vacant. LPA was informed by the LI that the last resident moved out of the facility on July 31, 2026. LPA, accompanied by the LI, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be vacant. LPA inspected all other common areas including the living, dining room, kitchen, and two car garage and observed them to be free of any hazards. LPA observed all of the facilities utilities to be operational during the visit. LPA confirmed during the visit that the facility is currently not operational and that there are no residents in care. LPA advised the LI of the closure procedures if they wished to surrender the facility license in the future. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Maricel Nepomuceno and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, Aug 12, 2026

Type of visit: Case Management - Health Checks

On July 15, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Shalemar Balignasay was notified via telephone and arrived shortly to assist with the visit. On today's visit, LPA observed that the facility currently has a census of three residents. LPA observed residents watching television in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and the attached two car garage. LPA observed them to be free of hazards. The garage is used for laundry and as caregivers' bedroom. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 114.6 and 117.5 degrees Fahrenheit. Fire extinguisher was maintained on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. Continued on LIC 809-C. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff, including Administrator, and one resident. Staff interviewed stated they have been paid in full and on time. Staff denied any issues with groceries or utilities. Based on this inspection, there are deficiencies observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. Civil penalties were assessed. This report was reviewed with Administrator and a copy of this LIC809 report was reviewed and provided at the facility. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Jul 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a) · Plan of correction due date: Jul 16, 2026

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: This requirement is not met as evidenced by: Based on observation and interview, staff are residing in the garage which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2026

Plan of correction: AD agreed for staff to remove their belongings from these areas. AD also agreed to provide a written plan to LPA stating what the living arrangements are going to be for these staff. AD agreed to provide the statement to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87506(a) · Plan of correction due date: Jul 16, 2026

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observation and interview, Resident #1's file is in another facility location, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2026

Plan of correction: AD agreed for obtain resident's file and ensure it is kept at the facility and available at all times. AD will submit proof to LPA by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jul 16, 2026

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Based on observation and record review, Staff #3 (DOH: 07/01/26) is cleared, but not associated with the facility at the time of the visit, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 15, 2026

Plan of correction: Licensee will ensure all staff are cleared and associated with the facility according to CCR (87355)(e)(3). Administrator will provide proof of an updated roster to CCLD by the Plan of Correction (POC) due date.

Type of visit: Case Management - Health Checks

On June 23, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone and provided verbal consent that one of the caregivers can sign on her behalf. On today's visit, LPA observed that the facility currently has a census of five residents. LPA observed residents watching television and sleeping in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and the attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 109.9 and 115.5 degrees Fahrenheit. Fire extinguisher was maintained on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. Continued on LIC 809-C. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff, including Administrator (over the phone), and one resident. Staff interviewed stated they have been paid. Staff denied any issues with groceries or utilities. Based on this inspection, there are deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. Civil penalties were assessed. This report was reviewed with authorized representative and a copy of this LIC809 report was reviewed and provided at the facility. Appeal Rights reviewed.the state’s words, verbatim · CDSS document, Jun 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: Jun 24, 2026

§1569.38 (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license.. (cont.) is posted, or any other easily accessible location in the facility. Based on observation, the Licensee did not ensure a notice regarding the proceedings was posted at the facility.the state’s words, verbatim · CDSS document, Jun 23, 2026

Plan of correction: Licensee was informed by LPA that a copy of the Accusation was provided to the facility and staff posted in a prominent location by the front door.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jun 24, 2026

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Based on observation and record review, Staff #2 (DOH: 06/18/26) are cleared, but not associated with the facility, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 23, 2026

Plan of correction: Administrator will ensure all staff are cleared and associated with the facility according to CCR (87355)(e)(3). Administrator will provide proof of an updated roster to CCLD by the Plan of Correction (POC) due date.

Type of visit: Case Management - Health Checks

On May 22, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone and later arrived to assist with the visit. On today's visit, LPA observed that the facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and the attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 112.1 and 116.7 degrees Fahrenheit. Fire extinguisher was maintained on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. Continued on LIC 809-C. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff, including Administrator, and one resident. Staff interviewed stated that they were paid on May 15 and will be paid on May 22, 2026. Staff stated they are not owed a remaining balance on their paychecks. Staff said they will return to a biweekly pay schedule moving forward and don't have any issues with payments at this time. LPA observed that the outstanding annual fees has been paid as of April 1, 2026. LPA received proof of payment via email. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 report was reviewed and provided at the facility.the state’s words, verbatim · CDSS document, May 22, 2026

Type of visit: Case Management - Health Checks

On May 5, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via phone about the visit, but was unable to assist LPA with the inspection. On today's visit, LPA observed that the facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and the attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 111.9 and 117.6 degrees Fahrenheit. Fire extinguisher was maintained on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. Continued on LIC 809-C. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff, including Administrator, and one resident. Staff interviewed stated that they were paid on May 1, 2026. Staff stated they are not owed a remaining balance on their paychecks. Staff will be paid on a weekly basis moving forward and stated they don't have any issues with payments. LPA observed that the outstanding annual fees has been paid as of April 1, 2026. LPA received proof of payment via email. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was provided and left at the facility.the state’s words, verbatim · CDSS document, May 5, 2026

Type of visit: Case Management - Health Checks

On April 20, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson arrived shortly after to assist LPA with the inspection. On today's visit, LPA observed that the facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and the attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 112.6 and 116.6 degrees Fahrenheit. Fire extinguisher was maintained on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. Continued on LIC 809-C. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff, including Administrator, and one resident. Staff interviewed stated that they were paid on April 17, 18, and 20, 2026. Staff stated they are not owed a remaining balance on their paychecks. Staff will be paid on a weekly basis moving forward and stated they don't have any issues with payments. LPA observed that the outstanding annual fees has been paid as of April 1, 2026. LPA received proof of payment via email. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 report was provided and left at the facility.the state’s words, verbatim · CDSS document, Apr 20, 2026

Type of visit: Case Management - Health Checks

On April 8, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone, answered questions over the phone, and provided verbal agreement that caregiver Lesly Dacula can sign the report on her behalf. On today's visit, LPA observed that the facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and the attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 110.8 and 112.6 degrees Fahrenheit. Fire extinguisher was maintained on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. Continued on LIC 809-C. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff and one resident. Three out of the three staff interviewed stated that they were paid on April 5, 2026, and they are not owed a remaining balance on their paychecks. Staff stated they will be paid on a weekly basis moving forward. LPA observed that the outstanding annual fees has been paid as of April 1, 2026. LPA received proof of payment via email. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was provided and left at the facility.the state’s words, verbatim · CDSS document, Apr 8, 2026

Type of visit: Case Management - Health Checks

On April 3, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone, answered questions over the phone, and provided verbal agreement that caregiver Lesly Dacula can sign the report on her behalf. On today's visit, LPA observed that the facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room and their own rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 108.6 and 113.1 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C. LPA additionally conducted interviews with three staff and one resident. Three out of the three staff interviewed stated that they were paid on March 29, 2026, and they are not owed a remaining balance on their paychecks. Staff stated they will be paid on a weekly basis moving forward. LPA observed that the outstanding annual fees has been paid as of April 1, 2026. LPA received proof of payment via email. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was provided and left at the facility.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Case Management - Health Checks

On March 26, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone and provided verbal agreement that caregiver Lesly Dacula can sign the report on her behalf. On today's visit, LPA observed that the facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room and their own room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 109.5 and 113.5 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C. LPA additionally conducted interviews with three staff and one resident. Three out of the three staff interviewed stated that they were paid on March 24, 2026, and they are not owed a remaining balance on their paychecks. Based on interviews from the previous case management visit, staff were supposed to be paid on March 22, 2026. LPA observed that there remains an outstanding annual fee in the amount of $741.50. LPA reminded administrator that the amount was due in October 25, 2025 and advised her to inform management to make a payment as soon as possible otherwise the balance will accrue. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. This report was reviewed with authorized representative and a copy of this LIC809 and LIC809-D report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Mar 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87156(a) · Plan of correction due date: Apr 2, 2026

87156 Licensing Fees: (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not pay the facility's annual fees for 2025 depsite previous reminders. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: The Licensee stated that he will pay the facility's annual fees. The Licensee agreed to provide LPA proof of payment via email or fax by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 27, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on time. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay on time. The financial plan shall be submitted via email or fax by POC date.

Type of visit: Case Management - Health Checks

On March 20, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone and provided verbal agreement that caregiver can sign the report on her behalf. On today's visit, LPA observed that facility currently has a census of four residents. LPA observed residents watching television and sleeping in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 108.5 and 112.4 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C. LPA additionally conducted interviews with three staff and one resident. Three out of the three staff interviewed stated that they were paid on March 11, 12, 18, 2026, and they are not owed a remaining balance on their paychecks. LPA observed that there remains an outstanding annual fee in the amount of $741.50. LPA reminded administrator that the amount was due in October 25, 2025 and advised her to inform management to make a payment as soon as possible. Financial records have been received as of March 6, 2026. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. This report was reviewed with authorized representative and a copy of this LIC809 and LIC809-D report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Mar 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87156(a) · Plan of correction due date: Mar 27, 2026

87156 Licensing Fees: (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not pay the facility's annual fees for 2025 depsite previous reminders. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: The Licensee stated that he will pay the facility's annual fees. The Licensee agreed to provide LPA proof of payment via email or fax by POC date.

Type of visit: Case Management - Health Checks

On March 10, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Janine Cuyson was notified via telephone and later arrived to assist with the visit. On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television and sleeping in the living room. LPA, accompanied by AD, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 112.4 and 115.3 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with three staff and one resident. Two out of the three staff interviewed stated that they were paid on March 4, 2026, and they are not owed a remaining balance on their paychecks. One out of two staff reported they were not paid on March 7, 2026. LPA observed that there remains an outstanding annual fee in the amount of $741.50. LPA reminded administrator that the amount was due in October 25, 2025 and advised her to inform management to make a payment as soon as possible. Financial records have been received as of March 6, 2026. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. Additionally, civil penalties will be assessed on today's visit for failure to correct and repeat violation at the amount of $500. This report was reviewed with administrator and a copy of this LIC809, LIC809-D, and LIC421FC report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Mar 10, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87314 · Plan of correction due date: Mar 11, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on time. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 10, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay on time. The financial plan shall be submitted via email or fax by POC date.

Type of visit: Case Management - Health Checks

On March 5, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone. On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television and sleeping in their respective rooms. LPA, accompanied by a care giving staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 111.9 and 116.7 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with two staff. Two out of the two staff interviewed stated that they were paid on March 4, 2026, but it was a partial payment. However, two out of two staff reported they are not owed a remaining balance on their paychecks. LPA observed that there remains an outstanding annual fee in the amount of $741.50. LPA reminded primary caregiver that the amount was due in October 25, 2025 and advised her to inform the administrator to make a payment as soon as possible. LPA spoke with administrator on the phone and requested financial records, utility bills, and payroll records from October 2025 to January 2026. No financial records have been received as of March 5, 2026. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. Additionally, civil penalties will be assessed on today's visit for failure to correct and repeat violation at the amount of $250. This report was reviewed with administrator via telephone and a copy of this LIC809, LIC809-D, and LIC421F report was provided and left at facility. Administrator provided provided verbal consent for caregiver to sign on her behalf. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Mar 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 6, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on time. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 5, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay on time. The finacial plan shall be submitted via email or fax by POC date.

Type of visit: Case Management - Health Checks

On February 26, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone. On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television and sleeping in the living room. LPA, accompanied by a care giving staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms (2 shared and 2 private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 113.3 and 116.0 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facilities utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with two staff and one resident. Two out of the two staff interviewed stated that they were paid on February 24, 2026, but it was a partial payment. LPA observed that there remains an outstanding annual fee in the amount of $741.50. LPA reminded primary caregiver that the amount was due in October 25, 2025 and advised her to inform the administrator to make a payment as soon as possible. LPA spoke with administrator on the phone and requested financial records, utility bills, and payroll records from October 2025 to January 2026. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. Additionally, civil penalties will be assessed on today's visit for failure to correct and a repeat violation in the total amount of $850. This report was reviewed with administrator via telephone and a copy of this LIC809, LIC809-D report was provided and left at facility. Administrator provided provided verbal consent for caregiver to sign on her behalf. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Feb 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 27, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid in full. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay for previous pay that is due, and for pay periods moving forward. The finacial plan shall be submitted via email or fax by POC date.

Type of visit: Case Management - Health Checks

On February 19, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed that facility current has a census of five residents. LPA observed residents watching television in the living room and sleeping in their rooms. LPA, accompanied by a care giving staff, conducted a tour of the physical plant of the facility. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 108.1 and 112.4 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facilities utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with two staff. Two out of the two staff interviewed stated that they were supposed to be paid on February 13, 2026, but have not been paid as of today. Two out of two staff interviewed stated they will be paid this week. LPA observed that there is currently an outstanding annual fee in the amount of $741.50. LPA reminded administrator that the amount was due in October 25, 2025 and advised the administrator to make a payment as soon as possible. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. This report was reviewed with administrator and a copy of this LIC809, LIC809-D report was provided and left at facility. Appeal right were reviewed, and a copy provided.the state’s words, verbatim · CDSS document, Feb 19, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 20, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on schedule. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay for previous pay that is due, and for pay periods moving forward. the finacial plan shall be submitted via email or fax by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced case management visit for a Health & Safety check. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson arrived shortly after and met with LPA. On today's visit, LPA observed five residents in care and two staff present. LPA observed residents watching television in the living room and sleeping in their respective rooms. LPA observed residents to be in clean clothes. LPA, accompanied by the caregiver, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents' bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed the lights in each of the resident bedrooms to be operational. The water and toilets in each of the resident bathrooms were operational. The hot water temperature measured 115.9 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the pantry by the kitchen. LPA observed a spare refrigerator with additional food supply in the garage. No health or safety concerns were observed. Based on the observations made during today's visit, no deficiencies were cited. An exit interview was conducted with Administrator and a copy of the report as provided.the state’s words, verbatim · CDSS document, Feb 9, 2026

Type of visit: Case Management - Health Checks

On January 8, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced case management visit for a Health & Safety check. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone of the visit and confirmed that lead caregiver Lesly can sign on his behalf. On today's visit, LPA observed five residents in care and two staff present. LPA observed residents watching television in the living room and sleeping in their respective rooms. LPA observed residents to be in clean clothes. LPA, accompanied by the caregiver, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents' bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed the lights in each of the resident bedrooms to be operational. The water and toilets in each of the resident bathrooms were operational. The hot water temperature measured 111.9 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the pantry by the kitchen. No health or safety concerns were observed. LPA additionally conducted interviews with two staff and two residents. Based on the observations made during today's visit, no deficiencies were cited. An exit interview was conducted with lead caregiver Lesly Dacula and a copy of the report as provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Case Management - Health Checks

On November 4, 2025, Licensing Program Analysts (LPAs) Brandon Lopez and Garlli Tat made an unannounced case management visit for a Health & Safety check. LPAs were greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPAs observed five residents in care and two staff present. LPAs observed residents watching television in the living room. LPAs observed residents to be in clean clothes. LPAs, accompanied by the AD, conducted a tour of the physical plant. LPAs inspected the four resident bedrooms and observed them to be free of hazards. LPAs observed residents' bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPAs observed the lights in each of the resident bedrooms to be operational. The water and toilets in each of the resident bathrooms were operational. The hot water temperature measured 108.3 degrees Fahrenheit. LPAs observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPAs observed kitchen appliances to be clean and operational. LPAs observed the four burner gas stove lights unassisted. LPAs observed the facility has a three day emergency food and water supply stored in the pantry by the kitchen. No health or safety concerns were observed. LPAs additionally conducted interviews with three staff and five residents. LPAs advised the AD of the outstanding annual fee balance of $494.50. During the visit, LPAs requested the current liability insurance for the facility. Two staff interviews confirmed that the facility did not currently have liability insurance and that the liability insurance was not renewed when the previous policy expired. Continued on LIC809-C. Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D. An exit interview was conducted Administrator Eleazar Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Nov 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Nov 5, 2025

1569.605: Liability insurance; coverage requirements: ... all residential care facilities for the elderly, ... shall maintain liability insurance ... in the amount of ... ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, ..... This requirement is not evidenced by: Based on observation and interview, the Licensee did not ensure that the facility currently has liability insurance. Two staff interviews conducted confirmed the facility does not have liability insurance. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 4, 2025

Plan of correction: The Licensee stated that she is in the process of obtaining liability insurance for the facility. The Licensee stated that she will provide proof of the liability insurance once it has been obtained to LPA via email or fax by POC date.

Type of visit: Required - 1 Year

On October 16, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Eleazar Cuyson about the visit. For this visit, there are two staff members on duty, all of which are background cleared and associated. AD later arrived to assist with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located by the hallway. LPA observed the Administrator's Certificate for Eleazar Cuyson, which expires on May 27, 2026. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six non-ambulatory residents, none of which may be bedridden, and six may be on hospice. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of five non-ambulatory residents in care, two of which are on hospice, and none are bedridden. The facility is a single-story home. There are a total of four bedrooms, two of which are private resident rooms, and two are shared resident rooms. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. Smoke and carbon monoxide detectors are hardwired and auditory exit alarms were tested and operational. There are a total of two bathrooms. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 108.5 and 111.2 and degrees Fahrenheit. Continued on LIC 809-C. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguisher was dated and tagged on April 9, 2025. LPA observed the emergency disaster and evacuation plan, which is posted in the hallway. Facility had back-up emergency food and water supplies, located in the garage. LPA observed that the First Aid kit had all the required components. Medications are locked and stored in the storage room in the hallway. Toxins were also observed to be locked in the garage, inaccessible to residents in care. For the exterior portion, LPA observed patio furniture under covered shading, and the grounds were free of any hazards or obstructions. There are two self-latching gates in the backyard that can be opened in case of an emergency. No bodies of water were observed. During this visit, five resident files and three staff files were reviewed. One out of five residents did not have an Admission Agreement. LPA reviewed residents’ medication records and one resident and one staff interviews were conducted. Based on today's observations, there is a Technical Advisory being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Eleazar Cuyson. This report was reviewed with the administrator and a copy was provided at the end of the visit. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Oct 16, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. Five (5) residents currently reside at this location and hospice services are being provided to two (2) residents at this time. LPA arrived at facility was greeted at the door by caregiver and granted entry. Upon entry LPA observed there was three residents in living room watching TV, one caregiver in living room with residents, one caregiver in kitchen doing meal preparation and two residents in their bedrooms. During the case management visit LPA took a tour of the inside of the facility, restrooms and common areas. LPA observed the kitchen is clean and organized. LPA observed that the meal prepared appeared of good quality and storage areas organized. LPA inspected food supply adequate amount was observed to be within regulations. The facility has a two-day supply of perishables, and seven-day supply of non-perishable food is available as required by regulations. Knives and sharps objects are kept locked in a kitchen drawer. LPA observed the fire extinguisher charged and mounted in the wall in the kitchen with service date of April 9, 2025. LPA inspected that medication is centrally stored in a safe locked storage located in closet located in the main entry of the facility. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA observed the first aid kit, emergency backpacks and a first aid manual. LPA observed all resident rooms had the required furnishings. LPA observed all resident rooms are clean and organized. The facility stays at a comfortable temperature. LPA observed bathroom was clean and operational. LPA measured the hot water temperature which measured 108.1 Fahrenheit Degrees. LPA Continued on LIC809-C inspected the garage and door is kept locked. LPA observed the following an emergency food supply and water, there is a spare refrigerator with additional food supply, cleaning/toxic chemical are kept locked in storage, garage is used for storage, washer was in use and there was a dryer. Smoke detectors/carbon monoxide detectors tested operational. LPA toured the backyard, no bodies of water observed. There is a shaded seating area in the front yard and backyard for residents to sit. The exit gate is operational. No obstacles or hazards observed in the backyard. All staff present (3), Administrator and 2 caregivers, are background cleared and associated to the facility. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Jun 26, 2025

Type of visit: Office

On today's date, Licensing Program Managers (LPM) Alisa Ortiz and Licensing Program Analysts (LPAs) Michael Tea and Brandon Lopez met with Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy on this day for the purpose of discussing financial operations and distress and reporting requirements. The following was discussed: o Licensee's responsibilities of facility oversight o Licensee's requirement to maintain control of facility and property o Licensee’s responsibility to maintain financially solvent o Licensee’s responsibility to communicate with the Department o Report of suspected dissolution of partnership The following was agreed upon during today's meeting: · Licensees has clarified the dissolution of partnership is not related to license but rather a separate business deal. The dissolution of partnership will not impact Licensees facilities. · The Licensees has reported they are in communication with landlords for property’s leased and will maintain a valid lease and control of property. · The Licensees will maintain payment of all facility bills and ensure sufficient staffing to meet resident’s needs. The Licensee will communicate any health and safety concerns related to the residents in care to the Department immediately. The following items are to be provided to the Department: · Updated LIC 500 Personnel Report identifying all current working staff and their agreed upon schedules by close of business May 29, 2025. · Current lease agreements with letters from landlords voiding any outstanding evictions or unlaw detainers by close of business May 23, 2025. · A copy of loan contract to support financial solvency by close of business May 29, 2025. An exit interview was conducted Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy. A copy of this report, LIC 809, was provided to Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy.the state’s words, verbatim · CDSS document, May 22, 2025

Type of visit: Required - 1 Year

On November 1 2024, at 9:10am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Valeria Palomera. Administrator (AD) Bryant So arrived at the facility around 9:40am. The facility is licensed to operate for six (6) nonambulatory residents and have a hospice waiver for six (6) residents. The facility is a single story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, an outdoor covered seating areas, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with AD So. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be clean and operational. The water temperature measured at 107.4 degrees F to 111.0 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency safety drills was last conducted on October 1, 2024. First aid kit is maintained and contains all the necessary elements. Evaluation Report Continues on LIC 809-C Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (949-215-2721) remains available, and the facility has a device that can be used for video teleconference purposes. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen, and serviced on February 15, 2024. Liability Insurance is effective 12/01/2023 and expires on 12/01/2024. LPA Kim conducted an audit of four (4) resident files (R1-R4), four (4) staff files (S1-S4), and medication and medication administration review. LPA Kim conducted one (1) staff interview. A deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Bryant So.the state’s words, verbatim · CDSS document, Nov 1, 2024

Type of visit: Case Management - Other

On September 17, 2024, at 10:20am, Licensing Program Analysts (LPAs) Jessica Cho and Edward Kim conducted an unannounced case management visit for the purpose of interviewing Resident #1 (R1) in connection to a pending investigation at another licensed facility, Complaint Control Number: 22-AS-20240910152630. LPAs were greeted and granted entry by Caregiver Martha Zea and explained the purpose of the visit. Caregiver Zea notified Administrator (Admin) Bryant So by phone. Administrator Rochel Malaca was also advised of the visit by phone. LPAs spoke to Administrator So explaining the reason for the visit and authorized Caregiver Zea to sign the report on his behalf. During today's visit, LPAs interviewed R1 and obtained records of R1, such as Physician's Report and Face Sheet. An exit interview was conducted with Caregiver Martha Zea, and a copy of this report including the LIC811 were provided at the end of the visit.the state’s words, verbatim · CDSS document, Sep 17, 2024